Menopause is a normal and expected transition in a woman's life, signalling the end of her reproductive years, and is accompanied by a variety of physical and emotional symptoms that have a significant impact on her quality of life (Tatarchuk, 2019, Sorpreso and Isabel Cristina, 2015). Owing to the frequency and severity of these symptoms, there is a growing interest in integrative approach. As a result, medicinal plants and herbal formulations have received considerable attention as complementary methods to conventional hormonal therapy (HT) (Franco et al., 2016).

Studies, most notably the Women's Health Initiative (WHI) trial (Rossouw et al., 2002), have linked HT to an increased risk of breast cancer, heart disease, stroke, and blood clots. The findings from such studies have led many healthcare professionals to be more cautious in prescribing HT, and many women to be hesitant about using it, especially for extended periods (Manson et al., 2014).

Moreover, aside from health risks, some women experience side effects from HT that can range from mild, like bloating and breast tenderness, to more severe ones, such as nausea, mood swings, or headaches (MacLennan et al., 2004). Others may opt against HT due to personal, philosophical, or cultural beliefs, preferring natural or alternative treatments. For instance, some women gravitate towards integrative approaches that align with their personal health philosophies or those that have been traditionally practiced in their cultures (e.Silva Noll et al., 2022, Geller and Studee, 2006, Amaral et al., 2005). The combined concerns about potential risks, side effects, and individual beliefs underscore why conventional therapies like HT might not be suitable or desired by all women experiencing menopausal symptoms (Newton et al., 2002).

Recent studies have uncovered a variety of medicinal plants with potential therapeutic effects on menopausal symptoms, including compounds like phytoestrogens, triterpenoids, flavonoids, and terpenes (Dutra et al., 2016, Ameh et al., 2010). These compounds exhibit a variety of pharmacological properties, such as estrogen-like, antioxidant, anti-inflammatory, and vasodilatory effects (Gomes et al., 2023, Li, 2023, Li et al., 2021, Chen et al., 2015). Soybean, red clover, yam, passionflower, and sage are among the most popular plants used to treat menopausal symptoms (Marmitt et al., 2018). According to research, a sizeable proportion of women use medicinal plants for menopausal relief, and 24.9% of primary care patients who approach, or experience menopause reported using herbal products to alleviate menopause symptoms (Dailey et al., 2003). A meta-analysis of clinical trials conducted in 2016 showed that phytoestrogen supplementation was associated with a modest reduction in the frequency of hot flashes and vaginal dryness (Ghazanfarpour et al., 2016a, Ghazanfarpour et al., 2016b, Ghazanfarpour et al., 2016c, Ghazanfarpour et al., 2016d, Ghazanfarpour et al., 2016e).

Despite encouraging findings, the efficacy of medicinal plants and herbal formulations varies among individuals, and they may not be effective for everyone. Additionally, certain dietary supplements may interact with prescription drugs or cause adverse side effects if taken in excess. The long-term effects of using medicinal plants and herbal formulations to treat menopausal symptoms are not fully understood and may result in unintended health effects (Echeverria et al., 2021, Teschke and Axel, 2015)

In addition, the current literature on medicinal plants and herbal formulations for climacteric symptoms is marked by inconsistent study designs, lack of standardised methodologies, and inconsistent evidence quality (Dutra et al., 2016, Ameh et al., 2010).

In this systematic overview of the literature, we aimed to provide a comprehensive analysis of the best available evidence regarding the use of medicinal plants and herbal formulations for the treatment of climacteric symptoms, examining both their potential benefits and the publication bias of the results. Through a comprehensive systematic review, we will investigate the current state of research on these therapeutic options, identify knowledge gaps, and provide recommendations for future research in this burgeoning field.